Learning curve of laparoscopic hysterectomy and comparison with abdominal hysterectomy

Abstract

Introduction: Laparoscopic hysterectomy is the most emerging route with major drawback of long learning curve and longer initial time taken for surgery. Objectives: 1) To compare two different routes of hysterectomy: abdominal and laparoscopic in terms of surgical outcomes and complications. 2) To see the learning curve of laparoscopic hysterectomy. Material and Methods: 100 patients admitted for hysterectomy were divided into two groups of 50 each, first group planned for abdominal hysterectomy and second group planned for laparoscopic route. Data was collected regarding amount of blood loss, duration of surgery, post operative requirement of analgesics, duration of hospital stay, and post operative complications in both groups. Results: The main indications for hysterectomy were fibroid, AUB, adenomyosis, endometrial hyperplasia and polyp in both groups. The average blood loss in TAH group (n=50) was 285 ml and in TLH group (n=50) was 246 ml (p=0.0588). Average blood loss in first 25 cases of TLH was 348 ml and in next 25 cases was 144 ml, which was highly significant. The average time taken in TAH group was 95 minutes, and in TLH group was 141 minutes (p=1.415E-13) which was highly significant. In TLH group, the average time taken in first 25 cases was 166 minutes and in next 25 cases it was 116 minutes which is significant. Requirement of analgesics and duration of stay was less in TLH group. Minor complications like fever, UTI were comparable in both groups. Conclusion: Learning curve of laparoscopic hysterectomy can be reduced with good team work, a proper selection of patients, and the use of good instruments.